Both groins were prepped and draped in usual sterile fashion. Initially, 20 cc of lidocaine was given to the right groin and #5 french sheath was inserted. Selective left and right coronary angiograms were performed over the regular wire in standard fashion. During this procedure, all the catheter exchanges were done over the wire. After that, a #5 french pigtail catheter was used to cross the aortic valve and left ventricular end-diastolic pressure was measured, and lv gram performed. After that, this catheter was pulled over the wire to the abdominal aorta and abdominal angiogram was performed, followed by pulling catheter into the right iliac and angiogram with distal runoff was performed. Chronic total occlusion in the left common iliac artery and stent was seen and then left groin access was performed by using doppler needle. Initially, a #5 french sheath was placed to the left common femoral artery. During this procedure, also we got an access on the left common femoral vein and #4 french sheath was placed to the left common femoral vein as well. After that, a #5 french sheath on the left side was upsized to a #7 french sheath. After that, by using a glidewire, the chronic total occlusion was crossed and the wire was placed in the abdominal aorta. Also, the storq wire was placed in the aorta from the right side. After that, a 6 x 80 mm mustang over the wire balloon was used to dilate the in-stent restenosis. This was successful. Two inflations were performed. Gradient was measured. There was no gradient between the left common femoral artery, right common femoral artery, and aorta. After that, the gradients were measured and selective angiogram demonstrated excellent angiographic results with no gradient seen. So, the #7 french sheath on the left side was exchanged to a #7 french short sheath and mynx groin closure was deployed to both groins without any complication. Hemostasis was achieved. The patient tolerated the procedure. No complications occurred.
Findings: Coronary arteries, left main coronary artery has 40% stenosis. Lad has mild luminal irregularities. No significant obstruction. Circumflex artery has minimal luminal irregularities. No significant obstruction. Right coronary artery has minimal plaquing. No significant obstruction. Left ventricular edp is measured. Abdominal angiogram has minimal plaquing. Right common iliac artery has approximately 30% stenosis. The right sfa and right common femoral has minimal plaquing. The right anterior tibial is not well seen; however, right peroneal and right posterior tibial are patent. There is a distal vessel runoff on the right side. Left common iliac artery in-stent restenosis is 100%. Also, left common femoral and left superficial femoral artery has minimal plaquing and there is three-vessel runoff in the left lower extremity.
We should not bill cpt code 75625